Job DescriptionJob SummaryLeads and directs team responsible for quality management and quality performance improvement activities. Responsible for overseeing, planning, and implementing new and existing health plan quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities, and provides support and implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state quality improvement compliance activities, including compliance with Healthcare Effectiveness Data and Information Set (HEDIS) regulations.
Essential Job Duties• Directs team responsible for the implementation of key quality program management strategies, including initiation and management of quality program management activities, surveys, audits, and other activities to meet state, federal and National Committee for Quality Assurance (NCQA) regulatory requirements.
• Oversees and leads health plan quality program management and performance activities in compliance with state, federal, and NCQA quality requirements.
• Represents the senior leadership team at internal Molina national and regional meetings; serves as subject matter expert for the health plan at state meetings, and actively oversees the completion of effective performance improvement projects.
• Collaborates with the national analytics and strategic teams to present and evaluate quality performance management program (QPMP) activities.
• Maintains structure and processes for quality program management, including maintenance and modification of quality policies and procedures, management and oversight of committee and workgroup structure, document management, report completion, and tracking of key deliverables.
• Prepares written reports and documents that clearly outline the quality program activities and ensure that member and provider feedback is incorporated into quality program management meetings, outcomes from these activities are documented, and continuous quality improvement tools are used to highlight the processes, interventions, and remeasurements are conducted to meet improvement goals.
• Maintains ongoing revision of policies and procedures reflective of state, federal and NCQA requirements for all quality program management functions by overseeing the ongoing incorporation and modification of requirements in state-specific policy addendums.
• Manages training and education of quality program management and performance staff in alignment with regulatory requirements.
• Ensures all quality program management and performance staff are well-versed in the requirements of the quality program and day-to-day work processes to support compliance with state contracts, policies and procedures, and program requirements.
• Implements tracking and trending of quality program requirements on an ongoing basis, including operational key performance indicators (KPIs), process reviews, and gap analyses.
• Utilizes proven quality improvement methods, such as the plan-do-study-act (PDSA) cycle, to facilitate individual, team, and organizational process improvement.
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals
• Same-day out-of-office travel approximately 0-50% of the time may be required, depending on health plan/state-specific needs.
• Multi-day out of town overnight travel approximately 0-20% of the time may be required, depending upon health plan/state-specific needs.
Required Qualifications• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.
• Advanced knowledge and understanding of HEDIS/NCQA.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.
Preferred Qualifications• Demonstrated experience in leading significant cross-functional work.
• Provider credentialing and subcontractor monitoring experience.
• Certified Professional in Health Quality (CPHQ).
• Certified HEDIS Compliance Auditor (CHCA).
• Registered Nurse (RN). If licensed, license must be active and unrestricted in state of practice.
- NCQA standard - understanding, knowledge and experience interpreting the standards and applying.
- NCQA accreditation audit experience and knowledge.
- Experience leading audits to ensure compliance with state contract and regulatory requirements.
- EPSDT and/or Texas Health Steps knowledge and experience.
- Performance Improvement Projects experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package.
